Obsessive Compulsive Disorder

Introduction

"He's an obsessive football fan" - "she's obsessive about shoes" - "he's a compulsive liar". We use these expressions when we talk about people who do something again and again, even when others can't see any reason for it. It isn't usually a problem and, in some lines of work, can even be helpful. However, the urge to do or think certain things repeatedly can dominate your life unhelpfully.

So, if:

• you get awful thoughts coming into your mind, even when you try to keep them out

or

• you have to touch or count things or repeat the same action like washing over and over

you could have Obsessive Compulsive Disorder (OCD).

What is it like to have OCD?

Liz     "I'm afraid of catching something from other people. I spend hours bleaching all the surfaces in my house to stop the germs, and wash my hands many times each day. I try not to go out of the house if possible. When my husband and children come back home, I ask them in great detail where they have been, in case they have visited somewhere dangerous, like a hospital. I also make them take off all their clothes, and wash themselves thoroughly. Part of me realises these fears are stupid. My family are sick of it, but it has gone on for so long now I can't stop".

John     "My whole day is spent checking that nothing will go wrong. It takes me an hour to get out of the house in the morning, because I am never sure that I've turned off all the electrical appliances like the cooker, and locked all the windows. Then I check to see that the gas fire is off five times, but if it doesn't feel right I have to do the whole thing again. In the end, I ask my partner to check it all for me again anyway. At work I am always behind as I go through everything several times in case I have made a mistake. If I don't check I feel so worried I can't bear it. Its ridiculous I know, but I think if something awful did happen, I'd be to blame".

Dawn     "I fear I will harm my baby daughter. I know I don't want to, but bad thoughts keep coming into my head. I can picture myself losing control and stabbing her with a knife. The only way I can get rid of these ideas is to say a prayer, and then have a good thought such as "I know I love her very much". I usually feel a bit better after that, until the next time those awful pictures come into my head. I have hidden away all sharp objects and knives in my house. I think to myself "you must be a horrible mother to think like this. I must be going mad".

OCD has three main parts:

1. the thoughts that make you anxious (obsessions)

2. the anxiety you feel

3. the things you do to reduce your anxiety (compulsions).

What you think (obsessions)

• Thoughts - single words, short phrases or rhymes that are unpleasant, shocking or blasphemous. You try not to think about them, but they won't go away. You worry that you might be contaminated (by germs, dirt, HIV or cancer), or that someone might be harmed because you have been careless

• Pictures in your mind - showing your family dead, or seeing yourself doing something violent or sexual which is completely out of character - stabbing or abusing someone, or being unfaithful. We know that people with obsessions do not become violent, or act on these thoughts.

• Doubts - you wonder for hours whether you might have caused an accident or misfortune to someone. You may worry that you have knocked someone over in your car, or that you have left your doors and windows unlocked

• Ruminations - you endlessly argue with yourself about whether to do one thing or another so you can't make the simplest decision.

• Perfectionism - you are bothered, in a way that other people are not, if things are not in the exactly the right order, not balanced or not in the right place. For example, if books are not lined up precisely on a bookshelf.

The anxiety you feel (emotions)

• You feel tense, anxious, fearful, guilty, disgusted or depressed.

• You feel better if you carry out your compulsive behaviour, or ritual - but it doesn't last long.

What you do (compulsions)

• Correcting obsessional thoughts - you think alternative 'neutralising' thoughts like counting, praying or saying a special word over and over again. It feels as though this prevents bad things from happening. It can also be a way of getting rid of any unpleasant thoughts or pictures that are bothering you.

• Rituals - you wash your hands frequently, do things really slowly and carefully, perhaps arrange objects or activities in a particular way. This can take up so much time that it takes ages to go anywhere, or do anything useful.

• Checking -  your body for contamination, that appliances are switched off, that the house is locked or that your journey route is safe.

• Avoidance - of anything that is a reminder of worrying thoughts. You avoid touching particular objects, going to certain places, taking risks or accepting responsibility. For example, you may avoid the kitchen because you know you will find sharp knives there.

• Hoarding - of useless and worn out possessions. You just can't throw anything away.

• Reassurance - you repeatedly ask others to tell you that everything is alright.

How common is OCD?

About 1 in every 50 people suffer from OCD at some point in their lives, men and women equally. That adds up to about 1 million people in the U.K. Famous sufferers may have included the biologist Charles Darwin, the pioneer nurse, Florence Nightingale, and John Bunyan, author of Pilgrim's Progress.

If you gamble, eat or drink 'compulsively', do you have OCD?

No. The words 'compulsive' and 'obsessive' are sometimes used to describe people who gamble, drink alcohol, use street drugs – or even exercise too much. However, these behaviours can be pleasurable. The compulsions in OCD never give pleasure – they are always felt as an unpleasant demand or burden.

How bad can OCD get?

It varies a lot, but work, relationships and family life are all more productive and satisfying if you are not constantly having to cope with OCD. Severe OCD can make it impossible to work regularly, to take part in family life – or even to get on with your family. In particular, they may become upset if you try to involve them in your rituals.

Are people with OCD 'mad'?

No - but you may be reluctant to seek help if you think that that others will think you are mad. Although you may worry that you will lose control, we know that people with OCD don't.

Other conditions similar to OCD

• Body dysmorphic disorder, or 'the distress of imagined ugliness'. You become convinced that part of your face or body is the wrong shape, and spend hours in front of a mirror checking and trying to cover it up. You may even stop going out in public.

• An urge to pluck your hair or eyebrows (Trichotillomania)

• A fear of suffering from a serious physical illness, such as cancer (Hypochondriasis)

• People with Tourette's syndrome (where a sufferer may shout out suddenly, or jerk uncontrollably) often have OCD as well.

• Children with some forms of autism, like Asperger's syndrome, can appear to have OCD because they like things to be the same, and may like to do the same thing over and over again, to help them feel less anxious.

When does OCD begin?

Many children have mild compulsions. They organise their toys very precisely, or avoid stepping on cracks in the pavement. This usually goes away as they grow older. Adult OCD usually begins in the teens or early twenties. Symptoms can come and go with time, but sufferers often don't seek help until they have had OCD for many years.

What is the outlook without help or treatment?

Many people with mild OCD improve without treatment. This does not usually happen with moderate to severe OCD, although there may be  times when the symptoms seem to go away. Some will slowly get worse, for others the symptoms get worse when they are stressed or depressed. Treatment will usually help.

What causes OCD?

Genes: OCD is sometimes inherited, so can occasionally run in the family. 

Stress: Stressful life events bring it on in about one out of three cases.

Life changes: Times where someone suddenly has to take on more responsibility – for example, puberty, the birth of a child or a new job.  

Brain changes: We don't know for certain, but if you have the symptoms of OCD for more than a short time, researchers think that an imbalance of a chemical called serotonin (also known as 5HT) develops in the brain. 

Personality: If you are a neat, meticulous, methodical person with high standards you may be more likely to develop OCD. These qualities are normally helpful, but can slip into OCD if they become too extreme.

Ways of thinking: Nearly all of us have odd or distressing thoughts or pictures in our minds at times - "what if I stepped out in front of that car?" or "I might harm my child". Most of us quickly dismiss these ideas and get on with our lives. But, if you have particularly high standards of morality and responsibility, you may feel that it's terrible to even have these thoughts. So, you are more likely to watch out for them coming back – which makes it more likely that they will.

What keeps OCD going?

Surprisingly, some of the ways in which you help yourself can actually keep it going:

• Trying to push unpleasant thoughts out of your mind - this usually only makes the thoughts return. Try not to think of a pink elephant for the next minute – you will probably find it difficult to think of anything else. 

• Rituals, checking, avoiding and seeking reassurance will all make you less anxious for a short time - especially if you feel that this might prevent something dreadful from happening.  But, every time you do them, you strengthen your belief that they stop bad things from happening. And so you feel more pressure to do them.... and so on.

• Thinking neutralising thoughts – if you spend time 'putting right' a disturbing thought with another thought (for example, counting to ten) or picture (for example, seeing a person alive and well) – then stop it, and wait until your anxiety goes away.

Helping yourself

• Expose yourself to your troubling thoughts

• It sounds odd, but it's a way of getting more control of them. You record them and listen back to them, or write them down and re-read them. You need to do this regularly for around half an hour every day until your anxiety reduces.

• Resist the compulsive behaviour, but not the obsessional thought.

• Don't use alcohol to control your anxiety.

• If your thoughts involve worries about your faith or religion then it can sometimes be helpful to speak to a religious leader to help you work out if this is an OCD problem.

• Contact one of the support groups or websites listed at the end of this leaflet.

• Buy a self help book such as one of those listed at the end of this leaflet.